Abstract
The use of synthetic cannabinoids (SCBs) is associated with many severe adverse effects that are not observed with marijuana use. We report a unique case of a patient who developed rhabdomyolysis and acute kidney injury (AKI) requiring dialysis after use of SCBs combined with quetiapine. Causes for the different adverse effects profile between SCBs and marijuana are not defined yet. Cases reported in literature with SCBs use have been associated with reversible AKI characterized by acute tubular necrosis and interstitial nephritis. Recent studies have showed the involvement of cytochromes P450s (CYPs) in biotransformation of SCBs. The use of quetiapine which is a substrate of the CYP3A4 and is excreted (73%) as urine metabolites may worsen the side effect profiles of both quetiapine and K2. SCBs use should be included in the differential diagnosis of AKI and serum Creatinine Phosphokinase (CPK) level should be monitored. Further research is needed to identify the mechanism of SCBs nephrotoxicity.
Highlights
acute kidney injury (AKI) is the abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of volume and electrolytes [1]
Rhabdomyolysis is characterized by muscle necrosis and the leakage of muscle-cell contents like electrolytes, myoglobin, and sarcoplasmic proteins (CPK, aldolase, lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase) into the circulation [2]
We are reporting a unique case of a patient with history of Cannabis dependence and paranoid schizophrenia who developed severe rhabdomyolysis and AKI requiring dialysis after use of K2 combined with quetiapine
Summary
AKI is the abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of volume and electrolytes [1]. Cannabis is the most commonly used illegal substance in the world [4] It contains over 400 compounds, including more than 60 cannabinoids. SCBs have multiple brand names most commonly “Spice” or “K2” and many street names such as “Fake Pot” [5] They are a heterogeneous group of compounds developed to probe the endogenous cannabinoid system (ECS) [4, 5]. In March 2012, 16 cases of AKI after SCBs use were reported in six states [8]. We are reporting a unique case of a patient with history of Cannabis dependence and paranoid schizophrenia who developed severe rhabdomyolysis and AKI requiring dialysis after use of K2 combined with quetiapine. CK: Creatine Kinase, BUN: Blood Urea Nitrogen, AST: Aspartate Transaminase, and ALT: Alanine Transaminase
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
